| Robert 2005-06-29, 5:54 pm |
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<alfred_pitchally@hotmail.com> wrote in message
news:1119983970.373203.5460@g49g2000cwa.googlegroups.com...
> In a case of sudden-onset hemolytic anemia due to the presence of cold
> agglutinins, how would you be able to discern whether a CMV infection
> or a B-cell lymphoma was the root cause? Would there be any way to
> tell from a standard CBC? Or would you recommend additional tests?
>
> Thanks for any information and/or pointers to the literature!
>
> -Al
>
> P.S. I was reading that IgM antibodies are indicative of a primary
> infection by CMV and that IgG antibodies are indicative of an inactive
> or latent infection by the virus. Could this information be used to
> determine whether someone had an active CMV infection causing the
> hemolysis? Or would this condition be indistinguishable from cold
> agglutinins due to a B-cell lymphoma? Thanks for your help!
>
Sorry about your lose.
Here is a link about CMV and coronary artery disease that tells you some
problems related to infections and trying to determine their role in
disease, it is not just infection but the host response to infection that
is important.
http://circ.ahajournals.org/cgi/con...ull/100/13/1366
To your first question, I remember reading an editorial written by Dr. Ira
Shulman of USC, which was telling blood bankers to convey the presence of
cold agglutinins in an effective manner to the clinicians. There was a case
history mentioned in which a lymphoma diagnosis was delayed because even
though the blood bank found a direct coombs positive cold agglutinin, the
doctor was unable to interpret that reaction. I interpreted that to mean
that the pathologist should have consulted the doctor on that or a written
comment by the pathologist would been better.
With regard to the CBC, the morphology can be overlapping in reactive
lymphocytosis and lymphoma. Flow cytometry studies are needed to see the
monoclonality of any cells present denoting a lymphoma.
There is one reference of the presence of CMV infected endothelial cells
present in the feather tip of the smear where all the large cells found. It
is unusual to see large endothelial cells on smear but would suggest CMV
especially if nuclear inclusion are present with special stains.
CMV infected cells may also been seen in urine samples for cytology.
I remember the last case I was involved with was a gram stain the doctor
wanted my to review for pathogens looking for a cause of the pneumonia. It
looked like normal flora and I told her so.
She also indicated that their was liver involvement and it still did not
register. Viral pneumonia gives normal flora sputum gram stains and CMV
involves the liver. It is similar to EB mononucleosis. The patient succumbed
within a day, after the PCR results came back positive in most sites tested.
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